Psychopharmacology

Medication against mental illness has always been an iffy topic full of taboo. Many believe we are being over-medicated, that mental illness should be treated mentally through therapy and not physically through medication, and so on and so forth. I tend to fall more towards the “no medication” than the “yes medication” end of the discussion. But I also think it is unwise to refuse medication entirely. I realize that my feelings on the matter are just feelings, not actual facts, and ultimately irrational.

I’ve never been a fan of antidepressants and am even less inclined to like antipsychotics. A big part of it is an irrational fear that the drugs will turn me into a completely different person somehow. Like the drugs will make me think and feel different than I normally do. But you could also say that my disorder makes me think and feel differently than I normally would. When you’re sick for so long, it can be difficult to discern where you end and the illness or disorder begins. Am I me or am I just the drugs?

Another big part of my reluctance to take any medication is, I’m embarrassed to take them. Especially when I visit my dad on the weekends. I don’t want him to see me take any pills. It’s a stupid, stupid reason not to take medication, I know. Even so, when I was on antidepressants, I often found myself “forgetting” to bring the pills or forgetting to take them when I did bring them. When I finally took them, I’d always covertly swallow them while no one was looking.

Because of my own stance on medication and the fact my symptoms have always been relatively mild as far as I can tell, my experience with medication is very limited. I’ve been on mild antidepressants twice in my life. Both times I abruptly stopped taking the medication. I’ve never been on antipsychotics. Why would I want antipsychotics when I’m not psychotic? Although, perhaps the classification is a little misleading. Perhaps it’s more helpful to think of them as thought-regulating medication? On second thought, that might actually be worse… It’s silly to get hung up on names and specification, I know but what can you do? My brain’s just full of excuses.

I’ve heard some medication can help with excessive thoughts. I considered something like that, but my thoughts feel more slow and rusty than excessive and I was afraid the medication would somehow slow my thinking to a crawl or even stop completely. I should probably have talked more about this with my psychologist at OPUS. Probably he would have been able to clarify what sort of medication does what and what might be a better fit for me. But I didn’t.

My biggest hang-up against psychopharmacology is perhaps the side effects. Sometimes, the side effects of some medication can be quite severe and it can feel a bit like cutting off a leg to save the arm. It’s a different kind of debility but still one way or the other, you’re still not whole. There are other medications you can take to treat some of the worse side effects, which is good. But at the end of the day, it’s just more pills to take and that can get a little exhausting just to think about.

The first time I took antidepressants, I was 18 and living at home in Nuuk, Greenland. I was diagnosed with mild depression and a visiting psychiatrist (meaning he worked there for a short time before returning to Denmark) prescribed me with Citalopram, I believe. It worked great for a couple of months. Then it stopped working. So I stopped taking them. I didn’t like my psychologist at the time either and when she failed to make a new appointment one session, I simply stopped coming. Instead of ineffective medication and useless psychologists, I decided to treat my own depression by making a point of exaggerating the enjoyment of the few things I still enjoyed. It worked well enough for a while. Focusing on the good things in life is helpful short-term, but if you don’t treat whatever’s making you miserable, eventually all those bottled up emotions are going to come crashing down. It may take years, but it’ll happen sooner or later.

The second time, I started taking basically the same drug, but a different brand because I felt mildly depressed while I was at OPUS and I had a lot of trouble sleeping. This time, I felt no difference at all from the drug after taking it for about a month. Rather, I suffered the unfortunate but very common side effect of being unable to orgasm or taking ages and ages to get there, without the actual intended benefit of the drug. And so, when I forgot to pick up my new prescription just before Christmas the year before last, I simply stopped taking the pills when I ran out. This turned out to be a very reckless move. As it turns out, going cold turkey on antidepressants can have some pretty uncomfortable side effects. Like dizzy spells. At first I thought it was simply lack of sleep that caused the dizziness, but after talking to my psychologist, I realized it was probably the drug. Thankfully, I didn’t suffer any worse side effects and the dizzy spells disappeared on their own.

I’ve heard a few other horror stories about medication, like the schizophrenic patient who spent her time drugged into a stupor and her medication messed with her hormones making her obese and grow unsightly facial hair that she hated so much she would escape into another world where she wasn’t sick and had a successful life with a career and family. Sometimes, I dream about being able to just park my body in some institution and disappear into my own head and live in my own dream world where everything is exactly how I want it. I feel like I’d be happier that way. But I’m much too proud to allow myself to live out my days like some institutionalized drugged-out potato.

So, do I believe psychopharmacology’s all bad and should be avoided at all costs? No. I do believe drugs can be helpful, even necessary. For all the horror stories, there are many more happy stories where drugs bring relief from internal torment and allow for a relatively normal life. I know someone who takes medication for her anxiety and it relieved her of the terrible stomach pains she suffered from due to the anxiety. I know of a family friend who takes antidepressants because he simply can’t function without them. I don’t think medication is the ultimate solution, but it can bring relief where it’s needed. Recognizing that need is an important step towards recovery.

If your own brain torments you so badly you can’t be in your own skin, if your anxiety is so bad it causes physical pain and leaves you trapped in your own head, if you feel so awful death seems the only escape? Then perhaps trading off happy-fun times with your favorite sex toy doesn’t feel like such a bad deal. And perhaps it won’t have to be for the rest of your life, but just until you’re in a better place overall. The important thing is, you get to a point where you can live well.

Diagnosis, yay or nay?

Let’s talk diagnoses for a second. Unlike with physical illnesses, mental illnesses often carry a stigma and a sense of judgement. This can, for some, make certain diagnoses very hard to accept and¬†creates conflict, which gets in the way of healing.

For many, being told you have a mental illness, such as schizotypal disorder, is like being told you’re a crazy person. Just hearing “schizo” might lead the mind to images of raving mad, paranoid lunatics babbling about some absurd conspiracy, or going on about voices only they can hear, telling them to do horrible things. It can be incredibly hard to see something like that in yourself or a loved one. Reality tends to look a lot different than in the movies. And sometimes reality described by one person can look very different for another. Maybe you went and read a quick description of the disorder and thought: “That doesn’t sound like me (or whoever), at all!” It can be a bit hard to interpret general descriptions into individual cases.

Most of us have an idea of what it means to be mentally ill. But when faced with it in reality, it becomes something different entirely and suddenly, we don’t know how to deal with it. Perhaps you’ve heard others say: “But you look/sound perfectly normal to me,” or “everybody gets a little X sometimes, doesn’t mean they’re sick,” or any such similar comment, which leaves you feeling misunderstood and dismissed. Maybe just imagining such reactions prevents you from talking about it at all. It’s such a difficult thing to come to terms with. If it’s not totally obvious, it’s far too easy to simply ignore.

Now then, the unthinkable’s happened: You’ve come home with/to a brand new mental illness. How do you take it? How should you take it?

There are several ways to view diagnoses, and depending on the perspective, the tone and feel of the word can change quite a bit. It can be a helpful tool, or a curse. If for one reason or another, you truly can’t accept your diagnosis, you don’t necessarily have to force yourself to. Just like with any medical diagnosis, there’s always the option of getting a second opinion from another professional, if you suspect the diagnosis doesn’t quite fit your problem. It is possible to receive a wrong diagnosis and if that is the case, it’s best to find the real problem as soon as possible.

Regardless of diagnosis, the important thing is that you receive the help you need. The aim is a better quality of life, not judgement. If that means adopting a certain label or accepting a certain diagnosis, perhaps it is better to focus on the opportunities offered rather than the constraints. The point of diagnosis is to identify the problem and establish a common ground for communication so the proper treatment can be found.

Just remember one thing: You are not your diagnosis! This way of thinking can, in some cases, be more harmful than good. There is a risk of becoming complacent in your illness.¬† It could be used as an excuse not to move beyond your comfort zone and thus prevent you from improving your life. i.e. “This is just who I am, so I don’t need to/can’t change”. Of course, that doesn’t mean you have to push yourself beyond your capabilities. Always know your limits.

So how do I view diagnoses, and how did I react to being diagnosed with Schizotypal Disorder?

To be honest, it was a relief. I felt validated somehow. Suddenly, I had proof that yeah, there actually was something wrong with me. And most importantly: there was a way to fix it, that there were people who could help me get me better. With the diagnosis came the treatment plan and others who lived with similar problems to mine. I was no longer quite so alone.

I like to see diagnoses as simply labels. Like on foods. When I say lasagna, we all know what I’m talking about. There’s the special pasta-sheets, the tomato sauce, bechamel sauce and cheese baked together into delicious, Italian goodness. In the same manner, Schizotypal disorder is simply a label with which to identify my personal set of mental problems. Like with lasagna, the specific ingredients that make up the individual case might vary, but there are enough similarities to justify the common label. Both lasagna bolognese and lasagna al forno fit under the label lasagna, even though they have inredients that set them apart.

(Edit: It occurred to me that lasagna is actually a terrible comparison and probably doesn’t make a whole lot of sense. Feel free to completely disregard the entire paragraph above. I apologize for the confusion, and the possible lasagna-craving.)

If I wanted, I could name each ingredient or symptom individually; but in most cases, simply using the label is more convenient. It’s not perfect, but it works well enough for me.

In between writing and editing this entry, I had an interesting conversation that made me rethink this whole topic. I found out someone I know could possibly have a schizoid personality disorder and my reaction upon hearing that was: That guy? Nooo, really? But he has a girlfriend and everything? I mean, isn’t someone with a schizoid personality disorder like a total misanthrope who wants nothing to do with other people at all? And that’s when I realized, I’ve still got so much to learn!

Labels aren’t just labels, they usually come with a certain understanding or preconception, maybe you’ll have some experience with a label, sometimes you don’t. But the thing to remember is: First judgement doesn’t have to be the final judgement. Taking an immediate dislike to a diagnosis is perfectly understandable. We judge things all the time. Sometimes we’re right, sometimes we’re wrong. I’ve had very negative first impressions of plenty of things I’ve ended up changing my mind on. Acceptance comes with understanding. The best thing we can do, is keep learning.

Perhaps I’ll write a bit about schizoid and other personality disorders as well once I know a little more about them.

 

TL;DR version:

Mental illness is hard to understand and unfair judgement sucks.

Reality is different from movies. Also, reality is sometimes different from reality.

If you don’t like the name, maybe just change it. The important thing is, you receive the help you need.

Your opinion and feelings do matter.

It’s okay to get something wrong, you can always change your mind. Seriously.